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Conn. Telehealth Legislation to Set Use, Coverage Requirements

By Kyle Murphy, PhD

- The Connecticut General Assembly appears set to pave the way for telehealth adoption in the Constitution State in light of the progress a piece of telehealth legislation has made recently.

Connecticut telehealth legislation would set requirements for providers, plans

First introduced in January 2015, the bill (the Substitute for SB 467) — An Act Concerning the Facilitation of Telehealth — gained momentum through March and April, most recently receiving a favorable report toward the end of last month. If enacted, the legislation would go into effect on Oct. 1, 2015.

The bill comprises two sets of requirements — one for telehealth providers and another for telehealth payers.

Providers intending to provide and be reimbursed for telehealth services (ranging from licensed physicians certified nutritionists) must meet four requirements. The first specifies the type of technology and communication — that is, "real time, interactive, two-way communication technology or store and forward technologies."

The second and third require that a provider "has access to, or knowledge of, the patient's medical history, as provided by the patient, or the patient's medical record, including the patient's primary care physician's name and address" and provides the patient with his license and contact information.

The fourth and final requirement for telehealth providers focuses on the quality of care delivered using telehealth technology as well as a caveat about testing and observation. "But when the standard of care requires the use of diagnostic testing and a physical examination, the provider may perform the testing or examination though appropriate peripheral devices (i.e., instruments he or she may use to examine a patient)," the substitute bill states.

In line with these four requirement, telehealth providers must inform patients about treatment methods, including the limitations of telehealth services, and obtain permission from patients to provide services using telehealth technology, which the provider is responsible for documenting. Additionally, the bill prohibits telehealth providers from prescribing schedule I, II, or III controlled substances using telehealth technology or charging special facility fees for telehealth services.

The requirements for telehealth payers (i.e., health plans) are much less specific than those for telehealth providers. Basically, the bill require these payers to treat telehealth coverage similarly to traditional in-person treatment.

The legislation, however, does prescribe specific prohibitions for telehealth payers:

1. excluding coverage solely because a service is provided through telehealth, provided telehealth is appropriate for the service;

2. having to reimburse a treating or consulting health care provider for any technical fees or costs associated with providing telehealth services; or

3. requiring preauthorization for “emerging telehealth services.” (The bill does not define an emerging telehealth service.)

As the review of the bill indicates, the state employee and retiree health plan would be exempt from this state health mandate although it does have a history of conforming with all state health mandates, so it would like follow suit.

The bill currently awaits another vote by the Connecticut Senate.


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